CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

Currently, Botswana’s national HIV treatment program does not provide ART free of charge to non-citizens (immigrants). Access to free ART services for this population may limit the ability to achieve epidemic control even when 90-90-90 targets for Botswana citizens have been achieved. Methods: The BCPP is a cluster randomized trial designed to evaluate the impact of a combination prevention package on population level HIV incidence in 30 rural or peri-urban communities in Botswana. HIV testing campaigns were conducted in the 15 intervention communities covering 80% of the households in each community from October 2013- February 2016 and included home-based and mobile testing. Interviews and HIV testing were offered to all persons >16 years, including non-citizens. HIV-positive participants not on ART, including non-citizens were referred to the local HIV clinic and offered support with linking to care. Results: In the 15 Combination Prevention communities, 38,608 persons were assessed for HIV status (tested or showed documentation of status). Three percent (1,209/38,608) self-reported being non-citizens. Fifty-seven percent (695/1,209) of non-citizens were men, 41% (492/1,209) were women, and 22 (2%) were unknown. Eighteen percent (222/1,209) were HIV-positive: 64% (143/222) of whomwere newly identified and 36% (79/222) had documentation of prior HIV positive status. Of all the HIV-positive non- citizens identified, only 27% (61/222) were on ART as compared to 71% (5,738/8,102) of citizens or spouses of citizens assessed. Conclusion: Non-citizens accounted for 3% of participants in this community testing campaign, and had an HIV prevalence of 18%. The vast majority did not know their HIV status, were newly diagnosed, and were not on ART. Although the proportion of non-citizens is small, their knowledge of HIV status and ART use are very low. Given the high ART coverage rates in the general population in Botswana, lack of free ART coverage for non-citizens may result in a disproportionate contribution to incident HIV infections and modeling the estimated impact on epidemic control in Botswana is recommended. 1018 CASCADE OF CARE OF HIV SEROCONVERTERS IN THE CONTEXT OF UNIVERSAL “TEST AND TREAT” Joseph Larmarange 1 , Mamadou H. Diallo 1 , Collins C. Iwuji 2 , Joanna Orne-Gliemann 3 , Nuala McGrath 4 , Mélanie Plazy 3 , Frank Tanser 5 , Rodolphe Thiébaut 6 , Deenan Pillay 5 , François Dabis 6 1 IRD, Paris, France, 2 Univ Coll London, UK, London, UK, 3 INSERM, Bordeaux, France, 4 Univ of Southampton, Southampton, UK, 5 Africa Hlth Rsr Inst, Mtubatuba, South Africa, 6 Univ de Bordeaux, Bordeaux, France Background: The ANRS 12249 TasP cluster-randomized trial aimed at evaluating the impact of a Universal Test and Treat (UTT) approach on population-based HIV incidence in rural KwaZulu Natal, South Africa. Previous results showed low rates of early linkage to HIV care and treatment and did not identify any incidence reduction. To optimize the impact of UTT, time to ART initiation and viral suppression must be shorten significantly, in particular among newly infected individuals. We describe here the longitudinal cascade of care for those seroconverting during the course of the TasP trial. Methods: Every six months between March 2012 and June 2016, resident members aged ≥16 years old were offered rapid HIV testing at home and asked independently to provide dried blood spot (DBS) samples. Those testing positive or who self-reported their positive status were referred to local trial clinics for ART initiation, regardless of their CD4 count (intervention) or according to national guidelines (control). Cases of HIV seroconversion were identified using multiple sources: repeat DBS, repeat rapid tests, HIV+ self-reports and clinic visits. Date of seroconversion was estimated using a random point approach. The HIV care status, for each day following seroconversion (M0), was computed using additional data collected on CD4 count, ART prescription, viral load and migration out of the trial area. Follow-up was right-censored by dates of death or trial closure if alive. Results: We observed 565 individuals acquiring HIV (244 in intervention arm; 321 in control arm). Among them, one year after seroconversion (M12), 22% out-migrated from the trial area. 57%were diagnosed (aware of their HIV status), 27%were actively in HIV care, 12%were on ART, and were 10% virally suppressed. The cascade was comparable in both trial arms, except for ART coverage, higher in the intervention arm (15%) than in the control arm (9%). Conclusion: The observed cascade of care was suboptimal in seroconverters despite the introduction of UTT services and a trial environment. This poor outcome was aggravated in this rural setting by out-migration considered here as loss to the cascade. Newly HIV-infected individuals need time to (re)test, initiate ART and reach viral suppression. This is one of the plausible explanations of the lack of effect of the UTT strategy on HIV incidence in our setting. For a UTT approach to be effective, innovative strategies to identify seroconverters and support them to engage in ART care promptly are required. 1019 FACTORS ASSOCIATED WITH LATE PRESENTATION FOR HIV CARE IN SOUTH AFRICA Henry Fomundam 1 , Abraham Tesfay 1 , Shelter Mushipe 1 , MyriamMosina 1 , Carol Boshielo 1 , Hanson Tebe 1 , Anna Larsen 2 , Mireille Cheyip 2 , Getahun Aynalem 2 , Yogan Pillay 3 1 Howard Univ, Pretoria, South Africa, 2 US CDC, Pretoria, South Africa, 3 South African Natl Dept of Hlth, Pretoria, South Africa Background: Many people living with HIV (PLHIV) are not aware of their seropositive status and are diagnosed late during the course of HIV infection in South Africa. This study aims to assess factors associated with late presentation for HIV care among newly diagnosed PLHIV in three high HIV-burden districts of South Africa. Methods: Data for this analysis were utilized from a study describing linkage and retention in HIV care and treatment among newly diagnosed PLHIV within 35 purposively selected facilities between June 2014 and March 2015. Patients with available CD4 results and/or documentation of WHO clinical staging were eligible for analysis and were categorized as “moderately” (CD4 count 351-500 cells/mm3 and WHO clinical stage I or II), “very” (CD4 count 201-350 cells/mm3 or WHO clinical stage III) or “extremely” (CD4 count < 200 cells/mm3 and/or WHO clinical stage IV) late presenters, or were deemed “early” presenters. Descriptive analysis was used to measure frequency of late presentation and variables independently associated with late presentation were assessed through ordinal multivariable regression analysis. Results: Among 12,413 newly diagnosed PLHIV, 8,138 (66%) had CD4 measurement and/or WHO staging indicating presentation to HIV care. Most were female (69%) and 50% were age ≤ 30 years of age. A total of 78% (6,377) PLHIV presented to care late, of which 19%were moderately late, 27%were very late, and 33%were extremely late. Controlling for all other factors, men (AOR = 2.70; CI: 1.50 – 4.94), non-pregnant women (AOR 1.47; CI: 1.36 – 1.56), those older than 30 years (AOR = 2.60; CI: 1.99 – 4.92), and those accessing care in facilities within townships and inner cities (AOR = 1.52; CI: 1.06 – 2.20) were more likely to present extremely late versus early. Risk factors for very late and moderately late versus early presentation to care were not significant. Conclusion: The majority of newly diagnosed PLHIV in this analysis presented for HIV care late in the course of HIV infection. While the existing South African health policies target pregnant women for linkage to HIV care and treatment services during antenatal care, similar policies should be developed to incentivize men, non-pregnant women, those over 30 years of age and those accessing care in facilities within inner city and urban townships toward early engagement with the health system. 1020 SOUTH AFRICA’S NATIONAL THIRD-LINE ART COHORT: DESCRIPTIVE ANALYSIS Francesca Conradie 1 , Matthew Fox 2 , Michelle A. Moorhouse 1 , Gary Maartens 3 , Willem D. Venter 1 , Mahomed-Yunus Moosa 4 , Khadija Jamaloodien 5 1 Univ of the Witswatersrand, Johannesburg, South Africa, 2 Boston Univ, Boston, MA, 3 Univ of Cape Town, Cape Town, South Africa, 4 Univ of KwaZulu-Natal, Durban, South Africa, 5 South African Natl Dept of Hlth, Pretoria, South Africa Background: The World Health Organization recommends that national antiretroviral therapy (ART) programs in resource limited settings develop policies for third-line ART. South Africa, with the largest HIV treatment program, is one of the only countries in sub-Saharan Africa that has access to third-line ART for patients who have failed both first-line non-nucleoside reverse transcriptase inhibitors (NNRTI) and second-line protease inhibitor (PI) based ART. We report on 152 public-sector patients in South Africa for whom third line treatment was requested. This may be the largest public sector cohort on third line agents in sub-Saharan Africa.

Poster and Themed Discussion Abstracts

CROI 2017 439